Transcript skin lesions

IN THE NAME OWNER OF BEAUTY
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The Integumentary System
Instructor:
Shahnaz pouladi
Bushehr Medical Science University
Nursing and Midwifery Faculty
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Three Layers of skin:
Epidermis:
Stratified squamous
epithelium; outer
layer is "keratinized"
or "cornified"
Dermis:
Dense irregular
connective tissue
Hypodermis:
Adipose connective
tissue (technically not
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part
of system)
Epidermis: Avascular.
Depends on blood vessels in underlying
dermis for its nutrition
Cells formed by
mitosis in deepest,
or basal layer, then
get pushed into
more superficial
layers or "strata"
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(Epidermis)
Stratum Basale = Single row of dividing cells
Stratum Spinosum = Three or four layers of cells;
Some cell division
Stratum Granulosum = Three or four layers of cells;
Actively synthesizing protein
keratin
Stratum Lucidum = One or two layers of dying cells
Stratum Corneum = Many layers of flat, dead, scale-like
cells full of keratin
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Primary cell type in epidermis = keratinocytes
which produce large amounts of protein keratin
Other cell types:
Melanocytes produce
pigment melanin &
transfer it to keratinocytes
Langerhans cells (really
macrophages) clean up
debris
Merkel cells detect touch
and pressure; transfer this
information to sensory
receptors in the dermis
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Dermis:
Dense irregular connective tissue
Separated from epidermis (stratified squamous epithelium)
by basement membrane
Highly vascular
Highly innervated
Two Layers:
Papillary layer just
below epidermis
Reticular layer
forms deep 80%
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Dermis = Dense irregular connective tissue. Thus:
Cells = Fibroblasts / Fibrocytes
Macrophages
Mast cells
Lymphocytes
etc.
Fibers = Collagen (therefore strong, flexible)
Elastic (therefore stretchable)
Weight gain tears collagen fibers producing striae
(stretch marks)
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Hypoderm (Subcutaneous Tissue)
• Primarily is adipose tissue
• Provides a cushion
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Appendages of the skin
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Appendages of the skin
Hair follicles and hair
Sweat glands
Sebaceous (oil) glands
Nails on fingers and toes
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Hair
- Distribuled over all skin except:
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palms of hands
soles of feet
nipples
glans of penis & clitoris
minor labia
Formed in follicles located deep in dermis
- Consists of layers of dead, highly keratinized keratinocytes
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Shaft
Root
Bulb
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Each hair is associated with:
One or more sebacious
(oil) glands
An arrector pili muscle
A plexus of nerves around
the root
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Hair
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The rate of growth varies
Hair loss
Hair growth by sex hormone
Different functions of hairs
Hair color
Hair quantity and distribution
Nails
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Nails:
- Tips of fingers and toes
- Thick layer of densely packed
keratinocytes
- Produced by nail matrix at
proximal end, hidden under
eponychium or cuticle
Average growth:
0.5 mm per week
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GLANDS OF THE SKIN
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Sebaceous (oil) glands:
- Branched tubular glands
- Duct opens into opening
of hair follicle
- Secretes sebum,
consisting of lipids,
proteins, carbohydrates,
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Sweat Glands
- 2 to 3 million
- Two types:
Merocrine: Distributed over all skin except nipples
(Eccrine) Simple coiled glands in dermis
Duct leads to sweat pore on surface
Secreted watery sweat for cooling
Apocrine: Located only in axillary, pubic, anal regions
Larger than eccrine glands
Duct opens into opening of hair follicle
Secretes thicker sweat, high content of
proteins and fats.
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Sweat is usually 99% water with a pH between 4
and 6
Sweat glands produce 500ml of insensible
perspiration (no noticable wetness)daily
Two specially modified sweat glands:
Ceruminous—found in the external ear
canal. Secretion combines with sebum and dead
epidermal cells to form earwax (keeps eardrum pliable,
canal waterproof and has a bactericidal effect)
Mammary --milk producing glands found
in the female breast (modified apocrine glands)
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Function of the
Skin
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Functions of the skin
• 1. Protection
– First line of defense
– Keratin: protects body from water loss, barrier for
environmental factors (stratum corneum)
– Melanin: keeps UV rays from penetrating
– Surface film: sweat, oil, etc
– Basal layer: composed of collagen(tissue
organization and regeneration, selective
permeability, physical barrier, bind)
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Functions of the skin
• 2. Sensation
– Pressure, touch, temp, pain, etc
– Two specialized receptors:
• Meissner corpuscle – detects light pressure
• Pacinian corpuscle – detects deep pressure
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Functions of the skin
• 3. Fluid balance
• The stratum corneum has the capacity to
absorb water
• Skin damage (burn)
• The skin is not completely impermeable to
water. (evaporation) 600cc/day
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Functions of the skin
• 4. Body temperature
– Body produces heat (metabolism of foods)
– Body releases 80% of heat through skin
– Three major physical processes for loss of heat
[radiation, conduction (evaporation), convection].
– On a hot day the skin releases almost 3000
calories of body heat (enough to boil five gallons
of water)
– Heat loss is controlled by negative feedback loop
– Skin blood flow
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Functions of the skin
• 3. Produces Vitamin D
– Uv rays combine with skin to make cholecalciferol
– Cholecalciferol is transported to the liver and
kidneys where it is changed to vit D
– Vitamin D is essential for preventing osteoprosis
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Functions of the skin
• Immune response function
• Langerhans cells facilitate the uptake of IgEassociated allergens
• Plays a pivotal role in the pathogenesis of
atopic dermatitis and other allergic disease
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Skin and Aging Process
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Assessment of the Skin
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Preparation
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Equipment
Well-lit Room
Comfortable Environment
Hand washing
Appropriate use of Gloves
Privacy/Draping
Organized Assessment
Explanations
PHYSICAL ASSESSMENT
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Physical Assessment
• Inspection
– Color
– Bleeding
– Ecchymosis
– Vascularity
– Lesions
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Physical Assessment
• Palpation
– Moisture
– Temperature
– Texture
– Turgor
– Edema
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• Color
– Normal=Uniformed whitish pink or brown
– Abnormal
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Cyanosis
Jaundice
Carotenemia
Albinism
Vitiligo
Cyanosis
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Jaundice
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Carotenemia
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Albinism
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Vitiligo
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Physical Assessment
• Bleeding, Ecchymosis, Vascularity
– Normal=No areas
– Abnormal
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Spontaneous Bleeding
Petechiae
Ecchymosis
Venous Star
Necrosis
Petechiae
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Ecchymosis
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Venous Star
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Necrosis
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Lesions
• Lesions
– Normal=No lesions except freckles, birthmarks,
nevi (flat moles)
– Abnormal
• Rashes
• Pressure Ulcers
• Burns
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SKIN LESIONS
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Kind of lesions in dermatology
1- Primary Skin Lesions
2-Secondary Skin Lesions
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PRIMARY LESIONS
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macule
• Flat, circumscribed skin
discoloration that lacks
surface elevation or
depression
• Lesser than 1cm
• Vitiligo
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Patch
• Flat, circumscribed skin
discoloration, a very
large macule
• Vitiligo
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Papule
• Elevated, solid lesion
<0.5 cm in diameter
• B.C.C
• Intradermal Nevi
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Plaque
• Elevated,
solid”confluence of
papule”>0.5 cm in
diameter that lacks a
deep component
• Psoriasis
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Nodule
• Elevated, solid
lesion>0.5 cm in
diameter, a largerdeeper papule
• Lipoma
• Rheumatoid nudule
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Vesicle
• Plaque that contains
clear fluid ,a blister
• Lesser than .5 cm
• Herpes simplex
• Herpes zoster
• Contact dermatitis
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Bulla
• Localized fluid
collection>0.5 cm in
diameter, a large vesicle
• Pemphigus vulgaris
• Bullous impetigo
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Pustule
• Vesicle or bulla that
contains purulent
material
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Folliculitis
Impetigo
Acne
Pustular psoriasis
Wheal (Hive)
• Firm,edematous,plaque
that is evanescent and
pruritic
• Urticaria
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Cyst
• Nodule that contains
fluid semisolidmaterial
• Sebaceous cyst
• Epidermal cysts
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SECONDARY
LESIONS
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Crust
• A collection of cellular
debris ,dried serum, and
blood
• Impetigo
• Herpes, eczema
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Erosion
• A partial focal loss of
epidermis, heals
without scarring
• Ruptured vesicles
• Scratch marks
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Scale
• Thick stratum corneum that
results from
hyperproliferation or
increased cohesion of
keratinocytes
• dandruff
• Psoriasis
• Dry skin
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Ulcer
• A full-thickness, focal
loss of dermis, heals
with scarring
• Bed sore
• Syphlis
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Fissure
• Vertical loss of
epidermis and dermis
with sharply defined
walls, crack in skin
• Chapped lips or hands
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Scar
• A collection of new
connective tissue, may be
hypertrophic or atrohic scar
• Burn
• Acne
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Atrophy
• Thinning of the
epidermis, dermis or fat
that cause depression in
the skin surface
• Aged skin
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Lichenification
• Focal area of thickened
skin produced by
chronic scratching or
rubbing
• Contact Dermatitis
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Keloid
• Hypertrophied scar
tissue, elevated,
irregular,
• Surgical incision
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Moisture
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Moisture
• Moisture
– Normal=Dry with minimum of Perspiration
– Abnormal
• Xerosis
• Diaphoresis
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Temperature
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Temperature
• Temperature
– Normal= warm; hands & feet slightly cooler
– Abnormal
• Hypothermia
• Hyperthermia
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Texture
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Texture
• Texture
– Normal=smooth, firm
– Abnormal
• Roughness
• Soft
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Turgor
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Turgor
• Turgor
– Normal=when skin is released, it should return to
original contour rapidly
– Abnormal
• Dehydration
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Edema
• Edema
– Normal=No edema present
– Abnormal
• Pitting edema is rated on 4 point scale
• 1+ is if the pitting lasts 0 to 15 sec
2+ is if the pitting lasts 16 to 30sec
3+ is if the pitting lasts 31 to 60sec
4+ is if the pitting lasts >60sec
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ASSESSING THE NAILS
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• Bacterial
Nail diseases
– Paronychia infections of the nail fold
can be caused by bacteria, fungi and
some viruses. The proximal and
lateral nail folds act as a barrier, or
seal, between the nail plate and the
surrounding tissue. If a tear or a
break occurs in this seal, the
bacterium can easily enter. this type
of infection is characterized by pain,
redness and swelling of the nail
folds. People who have their hands
in water for extended periods may
develop this condition, and it is
highly contagious.
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• Beau's Lines are nails that are
characterized by horizontal lines
of darkened cells and linear
depressions. This disorder may be
caused by trauma, illness,
malnutrition or any major
metabolic condition,
chemotherapy or other damaging
event, and is the result of any
interruption in the protein
formation of the nail plate. Seek a
physicians diagnosis.
• Koilonychia is usually caused
through iron deficiency
anemia. these nails show raised
ridges and are thin and
concave. Seek a physicians advice
and treatment.
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Onychorrhexis
Onychorrhexis
• Presence of longitudinal striations or
ridges
• A sign of advanced age but it can also
occur with the following:
–Rheumatoid arthritis
–Peripheral vascular disease
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ASSESSING THE HAIR
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• Color and texture
• Distribution (cyclophosphamide)
• Hair loss
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Androgenetic Alopecia - Male
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Androgenetic Alopecia - Male
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Androgenetic Alopecia - Female
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Alopecia Areata
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SKIN CONSEQUENCES OF SELECTED
SYSTEMATIC DISEASE
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Figs 24,25. Legs of two patients with diabetes mellitus. The patient on
the left is a teenage girl with insulin dependent diabetes. The patient on
the right is an adult onset diabetic. Both have multiple atrophic
hyperpigmented macules, so-called diabetic dermopathy.
Stasis Dermatitis - Early
• Large vessels are
damaged
• The skin suffers from
lack of nutrients
• Very dry and fragile
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Skin Infections
• Bacterial infections (around hair follicles)
• Fungal infections (areas that remain moist all
the time)
• Candida infections (around the border of the
area)
• Dermatophyte infections (around the toenails
and feet)
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Leg and Foot Ulcers
• Cause : Change in peripheral nerves in
diabetic cases
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DIAGNOSTIC EVALUATION
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Diagnostic Evaluation
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Skin biopsy
Immunoflurescence test
Identify the site of an immune reaction
Direct Immunoflurescence test
Indirect Immunoflurescence test
Patch testing
Skin scraping
Tzanck smear
Wood’s light examination
Clinical photographs
Skin biopsy
• Performed to obtain tissue for microscopic
examination by scalpel excision or by a skin
punch instrument
• Biopsy from skin nodules, plaque, blisters for
rule out of malignancy
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Patch testing
• For detect of allergy
• Apply suspected an allergen to normal skin
• Evaluation of patient response
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Skin Scrapings
• Tissue sample are scraped from fungal lesions
• Examine microscopically
• Infestations such as scabies
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Tzank Smear
• A test used to examine cells from blistering
skin conditions
• Evaluate microscopically
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Wood’s Light Examination
• Wood’s light is a special lamp that produces long-wave
ultraviolet rays, which result in a characteristic dark purple
fluorescence
• It is possible to differentiate epidermal from dermal lesions
and hypopigmented and hyperpigmented from normal skin
• Light is not harmful to skin or eyes
• Lesions that contain melanin be disappeared under ultraviolet
light
• Lesions that are devoid of melanin increases in whiteness
under ultraviolet light
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Clinical Photographs
• For detecting of the nature and extend of the
skin condition and progress or improvement
resulting from treatment
• Used if the characteristics of the mole are
changing
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Hidradenitis Suppurativa
• H.S is a chronic suppurative folliculitis of the
perineal, axillary, and genital area or under the
bereasts
• The cause is unknown but have a genetic basis
• Pathophysiology:
• Abnormal blockage of the sweat glands
• Management
• Hot compress and oral antibiotic
• Isotretinoin or acitretin drugs
• Incision and drainage
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Hidradenitis suppurativa
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Hidradenitis suppurativa
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SEBORRHEIC DERMATOSIS
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Seborrheic Dermatosis
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Seborrhea is excessive production of sebum
Exist in areas where sebaceous glands
Is a chronic inflammatory of the skin
Clinical manifestations:
Two forms: oily form and dry form
Oily form: moist or greasy, patches of yellow, with or
without scaling, slight erythema
- Forehead, nasolabial fold, scalp, axillae, groin,
breasts,
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Seborrheic Dermatosis
• Dry form:
- Flaky desquamation of the scalp with a profuse amount of
fine, powdery scales (dandruf)
- Medical management:
- Corticosteroid cream (glaucoma and cataract)
- In this disease develop secondary candida infection
- Treatment of dandruff: frequent shampooing (containing
selenium sulfide suspension, zinc pyrithione, salicylic acid,
sulfur compounds)
- Nursing management:
- Avoid external irritant, exessive heat, perspiration, rubbing
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Seborrheic Dermatosis
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Acne Vulgaris
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A.V is a common disorder affecting susceptible hair follicles
Face, neck, upper trunk
85% adolescents experience it
Affects 12-35 year olds
Pathophysiology:
During puberty, androgens stimulate the sebaceous glands
C/M
Close and open comedones (impacted of lipids, oils, keratin)
A.V is seen as erythematous papules, inflammatory pustule,
inflammatory cyst
Acne Vulgaris
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M/M
Goal:
Reduce bacterial colonies
Decrease sebaceous gland activity
Prevent of plugged
Reduce inflammation
Combat secondary infection
Minimize scarring
Acne Vulgaris
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1) Nutrition and Hygiene Therapy
Diet is not believed to play a major role
Good nutrition for increase of immune system
Washing of face two/day
Oil free cosmetic and cream
Acne Vulgaris
• Pharmacologic therapy
• 2) Topical Therapy:
• Salicylic acid or benzoyl peroxide are effective in
removing of plugs (some persons are sensitive)
• Use once daily and cause redness and scaling
• Benzoyl erythromycin
• Benzoyl sulfur
• Vitamin A acid (tretinoin)
• Avoid of sun
•115 Topical antibiotics
Acne Vulgaris
• Pharmacologic therapy
• 3) Systemic Therapy
• Oral antibiotics (tetracycline family
contraindicate)
• Synthetic vitamin A compound(retinoid) such
as isotretinoin that reduce sebaceous gland
size (side effect: cheilitis, dry and chafed skin)
• Isotretinoin is toratogen
• Estrogen therapy for female
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Acne Vulgaris
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4) Surgical Management
Comedo extraction
Injection of corticosteroid in lesions
Incision and drainage of nodular cystic
leasions
• Cryosurgery(freezing with liquid nitrogen)
• Abrasive therapy (dermabrasion)
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BACTERIAL SKIN INFECTIONS
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Bacterial Skin Infections
• Impetigo
• Impetigo is a superfatial infection of the skin caused
by staph., strep.
• Bullous impetigo
• The exposed areas of the skin involved
• Is contagious
• In all ages is seen but in children with poor hygiene is
common
• Follows pediculosis capitis, scabies, herpes simplex,
insect bites, poison ivy, eczema
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Bacterial Skin Infections
• Impetigo (cont.)
• C/M
• Red macules
• Thin-walled vesicles
• Crust
• M/M
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Systemic antibiotic therapy
Non bullous impetigo: benzathin penicillin, oral penicillin,
Bullous impetigo: penecillinase resistant penicillin (cloxacillin, dicloxacillin
Topical antibiotic therapy
Mupirocin (in small area) several times daily/week
Lesion must soaked before topical antibiotic
Impetigo
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Folliculitis, Furuncles, Carbuncles
• Folliculitis is an infection of bacterial or fungal
origin that arises within the hair follicles
• Lesions may be superficial or deep
• Single or multiple papules or pustules appear
close to the hair folicle
• Beard area in men and women’s leg
• Usually caused by staph.
• Pseudofolliculitis barbae (shaving bumps)
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Folliculitis
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Furuncle
• An acute inflammation arising deep in one or more
hair follicle and spreading into the surrounding
dermis
• Furunculosis is multiple or recurrent lesions
• Occur anywhere and more in pressure area
• Start as a small, red, raised, painful pimple after a
few days convert to furuncle (center become yellow
or black)
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Furuncle
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Carbuncle
• An abscess of the skin and subcutaneous tissue that
represents an extension of a furuncle that has
invaded several follicles and is large and deep seated.
• Usually caused by a staph
• Appear most commonly in thick skin and inelastic
• Result fever, pain, leukocytosis
• More likely in pt. with underlying systemic disease
(diabetes, hematologic malignancy, in person that
use immune suppressive drugs)
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Carbuncle
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Medical management
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Not to rupture protective wall of leasons
The boil or pimple should never be squeezed
Systematic antibiotic therapy:
Oral cloxacillin and dicloxacillin
Cephalosporin and erythromycin
When the pus has localized small, incision and
drainage induced
VIRAL INFECTIONS
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Herpes Zoster
• Commonly known as “shingles”
• Reactivation of latent VZV in dorsal root or
cranial nerve ganglion cells
• 10% of patients are > 50 & 50% of patients are
> 85 years old
• Lesions appear over several days, usually
resolve in 1-3 weeks
• Disease more severe/longer duration in
immunocompromised patients
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Herpes Zoster
• Severe HZ can be first sign of HIV of underlying
malignancy (often Hodgkin’s disease)
• Average adult has one episode over lifetime
• Patients with multiple episodes over a short
period of time indicate further investigation
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HZ – clinical manifestation
• Lesions often preceded by pruritis, tenderness and
pain and/or neurologic changes
• This pain often confused with Sciatica, renal/urinary
stones, cholecystitis (gallbladder disease,) and
pleural/cardiac disease
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HZ – clinical manifestation
• Lesions appear posteriorly, the progress in
anterior direction
• Presents as grouped papules, vesicles,
pustules and crusts on erythematous base
• Lesions spontaneously heal in 1-2 weeks
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HZ – clinical manifestation
• 50% of cases involve thoracic nerves
• 15-20% cervical or lumbar nerves
• Remainder involve sacral and cranial
nerve roots
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HZ – clinical manifestation
• Be wary of lesions presenting on nasal tip as this defines
involvement of nasociliary branch of ophthalmic division of
trigeminal nerve (CN V1)
• ~33% of cases of ophthalmic zoster involve CN V1
• Ophthalmic Zoster can be extremely destructive to eyeball
apparatus
• Zoster with nasal tip involvement indicates immediate
referral to ophthalmology for further investigation!
• May need IV antivirals
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HZ - Diagnosis
• Usually a clinical diagnosis based on
characteristic prodromal symptoms and
appearance
• Usually do viral culture for VZV
• Can also do skin biopsy for histopathology,
Tzanck smear, Antibody studies, etc.
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HZ - Treatment
• Immunization ~80% effective (Zostavax)
• Anti viral agents:
- Acyclovir (zovirax)
-Valacyclovir (valtrex)
- Famciclovir (famvir)
• Systemic corticostroid for pt.>50 years
• Triamcinolone injection under painful area as anti
inflammation
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PHN – Post Herpetic Neuralgia
• Syndrome defined by pain and/or other
neurologic symptoms
• Can last months to years beyond the illness
itself
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Herpes Zoster
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Herpes Simplex Virus (HSV)
• Two Strains of HSV: HSV 1 and HSV 2
• HSV 1 generally face/lips and HSV 2 generally
genitals/anal area.
• Virus doesn’t follow any rules: HSV 1 can appear on
genital and HSV 2 can appear on face
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Herpes Simplex Virus (HSV)
• On lips, also known as herpes labialis, cold sore or
“fever blister”
• On fingers, called herpetic whitlow
• On wrestlers and other athletes, called herpes
gladiatorum
• Inside mouth, called herpes gingivostomatitis
• Remember, can occur anywhere!
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Herpes Simplex Virus (HSV)
• HSV is a recurrent disease, which after initial
exposure and infection, ascends peripheral
sensory nerves to the nerve ganglion, where it
then resides in a latent fashion
• Virus contagious skin-to-skin contact or
exposure to fluid from active blisters.
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HSV – Clinical Presentation
• +/- malaise, fever, fatigue, headache
• burning/tingling
• 12-24 hours later, erythematous macules/patches
appear, soon followed by rapid development of
painful, yellow, fluid-filled vesicles
• Vesicles rupture 24-48 hours later leaving painful,
crusted ulcerations and erosions.
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HSV – Clinical Presentation
• Can present as pruritic red macules and patches, or
red papules mimicking acne vulgaris.
• Majority of patients with HSV are asymptomatic
carriers
• Trigger factors for eruption: Physical/emotional
stress, sunburn, trauma, fever, menstruation
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Complications
• Eczema herpeticum (managed with oral IV
acyclovir)
• Herpetic whitlow
• Intra uterine neonatal infection
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HSV - Diagnosis
• Often a clinical diagnosis
• Viral Culture for HSV 1/HSV 2
• Tzanck Smear
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HSV – Treatment
• Topicals: Acyclovir 5% ointment, Penciclovir
1% cream
• Oral meds: Acyclovir, valcyclovir (valtrex),
famciclovir (famvir)
• For severe, disseminated infections: IV
acyclovir, foscarnet
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Herpes Simplex Virus (HSV)
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FUNGAL SKIN INFECTIONS
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Fungal Skin Infections
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In some cases affect only the skin and its appendages
In other cases internal organs are involved
Secondary infection appear with bacteria or candida
The most common fungal skin infection is tinea that is called
ringworm
• Tinea infections affect the head, body, groin, feet, nails
• For diagnosis the scales are dropped onto a slide and added
potassium hydroxide
• Wood’s light be helpful
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Parasitic skin infections
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Pediculosis (lice) and Scabies (itch mite)
Pediculosis
Affects all ages
Three varieties of lice:
– Pediculus humanus capitis
– Pediculus humanus corporis
– Phthirus pubis
– Feeding of human blood
– Causes itching
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Pediculus humanus capitis
• Eggs close the scalp
• The young lice hatch in about 10 days and
reach maturity in 2 weeks
• Transmitted direct or indirect
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Pediculus corporis
and pubis
• An infestation of the body
• Appear in unwashed people or who live in
close sites
• Pediculosis pubis is more common
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Clinical manifestation
• Head lice are found most in back of the head
and behind the ears
• The eggs look like silvery , oval bodies
• Cause intense pruritus and lead to bacterial
infections such as impetigo and frunculosis
• Body lice lives in seams of cloths
• Pubic lice may coexist with STD such as
gonorrhea, herpes,or syphilis
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Medical Management
• Washing the hair with shampoo lindane or pyrethrin
compounds with piperonyl butoxide
• Comb hair with a fine-toothed comb dipped in
vinegar
• All articles should wish in hot water
• The room should be vacuumed frequently
• All family members have to treat
• Complication such as sever pruritus, pyoderma,
dermatitis treated with antipruritics, systemic
antibiotics, topical corticosteroids
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SCABIES
• An infestation of the skin by the itch mite
sarcoptes scabiei
• Appear In who with substandard hygieine
• + or – with sexual activity
• Involve the fingers and hand contact may
produce infection
157
Clinical Manifestation
•
•
•
•
•
Appear symptoms after 4 weeks
Pt. complain of sever itching
Ask from of the pt. about site of sever itching
Use of magnifying glass and penlight
Other site: elbows, knees, the edge of the feet, the point of
the elbows, around the nipples, axillary fold, under breasts,
the groin or gluteal fold, penis or scrotum
• One classic sign is itching at night
• Secondary lesions appear such as vesicle, papule, excoriation,
crust
158
Assessment and Diagnostic
Findings
• Confirm with Sarcoptes. scabiei or the mite’s hyproducts from
the skin
• M/M
• Instruction for take a warm, soapy shower and after dry and
cooling of the skin prescribe of scabicides
• Prescription of scabicide such as: lindane, crotamiton, or 5%
permetrin from the neck down for 12 to 24 hours
• One application may be enough
159
Scabies
160
CONTACT DERMATITIS
161
Contac Dermatitis
• An inflammatory reaction of the skin to physical, chemical, or
biologic agents
• Common causes of irritant dermatitis are soap, detergents,
scouring compounds, industrial chemicals
• C/M
• Pruritis, burning, erythema, edema, papules, vesicles, oozing,
secondary bacterial infections
• M/M
• Soap is not used until healing
• Cool, wet dressing
• Corticosteroid
162
NONINFECTIOUS INFLAMMATORY
DERMATOSIS
163
Psoriasis
• The most common skin disease
• 2% of population
• A chronic disease stem from a hereditary defect that cause
overproduction of keratin
• Most common in 15-35 years
• Pathophysiology
- Immunologic basis
• Trigger factors
- Emotional stress, trauma, infections, seasonal and hormonal
changes
- The cell in the basal layer of the skin divide too quickly and
164 the normal events of cell maturation and growth cannot occur
Psoriasis
• C/M
• Red lesions with raised patches of skin
covered with silvery scales that are pruritic
• Involve the nails in one half of the pt. with
pitting, discoloration, beneath the free edges,
and separation of the nail plate
• Bilateral symmetry of lesions
• Most in scalp, elbow, knee, back, genitalia, nail
• Arthritis
165
Psoriasis
• Assessment and diagnostic finding
- Presence of the classic plaque-type
lesions
- Sign of nail and scalp
- Skin biopsy has little diagnostic value
166
Psoriasis
•
-
167
M/M
Control of stress
Pharmacologic therapy:
Topical agents: topical corticosteroids and covering skin with occlusive
dressing, nonsteroidal treatments are calcipotriene ( a synthetic derivative
of calcitriol or vitamin D) and tazarotene ( topical retinoid)
Systemic agents:
Infliximab (a monoclonal antibody against tumour necrosis factor alpha
(TNF-α) used to treat autoimmune diseases)
Etanercept (a TNF inhibitor)
Efalizumb ( monoclonal antibody)
Alefacept ( immunosuppressive drug)
Adalimumab (the third TNF inhibitor)
M/M in Psoriasis
- Oral agents: methotrexate, cyclosporine A
(an immunosuppressant drug )oral retinoids
(Etretinate)
- Photochemotherapy: photosensitizing oral
medication with exposure to ultraviolet-A light
(PUVA).
- Photosensitizing medication (8methoxypsoralen)
- Phototherapy in the ultraviolet-B (UVB)
168
Psoriasis
169
BLISTERING DISEASE
170
Pemphigus
• Pemphigus is a group of serious disease of the skin
characterized by the appearance of bullae.
• An autoimmune disease involving IgG
• A blister forms from the antigen-antibody
• Highest incidence in Jewish or Mediterranean
• Associated with penicillins and captopril and myasthenia
gravis
• C/M
• Oral lesions that are painful, bleed easily and oozing,
Nikolsky’s sign
• Complications : secondary bacterial infection, fluid and
electrolyte imbalance, hypoalbuminemia
171
Pemphigus
• M/M
• Goals : prevent loss of serum and the
development of secondary infection and to
promote reepithelization
• Corticosteroid priscription
• Immunosuppressive agents : azathioprine,
cyclophosphamide, gold
• plasmapheresis
172
Pemphigus
173